title: Incidence and significance of Delphian node metastasis in papillary thyroid cancer.
abstract: OBJECTIVE
  The objective of this study was to determine the incidence and significance of Delphian node (DN) metastasis in papillary thyroid cancer.
  
  
  BACKGROUND
  Despite the historic association, the prognostic implications of thyroid cancer metastasis to the DN remain unclear.
  
  
  METHODS
  Retrospective analysis of 101 patients who underwent thyroid surgery from 2007 to 2009 for papillary thyroid cancer, and had their DN harvested ab initio. Of these, 25 had metastatic disease to the DN. DN status was correlated with clinical and pathologic factors including age, gender, tumor size, histologic variant, extra-thyroidal extension (ETE), and central and lateral nodal metastasis.
  
  
  RESULTS
  DN positivity was seen consequent to higher rates of ETE of the primary tumor (52% vs. 28%; P = 0.025) and is associated with further nodal metastases to the central (72% vs. 22%; P < 0.0001) and lateral (28% vs. 4%; P < 0.0001) neck compartments. DN positivity was also associated with heavier nodal burden, in terms of number of metastatic nodes (median 5 vs. 2 nodes; P = 0.005) and nodal size (median 1 cm vs. 0.5 cm; P = 0.03).
  
  
  CONCLUSIONS
  Metastatic involvement of the DN is often associated with ETE and increased incidence of metastatic disease to the central and lateral neck compartments. If the DN is positive on intraoperative frozen section, careful evaluation of the central and lateral nodal compartments is essential.
authors.affiliation: Department of Surgery, Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York 10065, USA. gopaliyer@yahoo.com
authors.forename: N Gopalakrishna
authors.initials: NG
authors.lastname: Iyer
authors.forename: Anumeha
authors.initials: A
authors.lastname: Kumar
authors.forename: Iain J
authors.initials: IJ
authors.lastname: Nixon
authors.forename: Snehal G
authors.initials: SG
authors.lastname: Patel
authors.forename: Ian
authors.initials: I
authors.lastname: Ganly
authors.forename: R Michael
authors.initials: RM
authors.lastname: Tuttle
authors.forename: Jatin P
authors.initials: JP
authors.lastname: Shah
authors.forename: Ashok R
authors.initials: AR
authors.lastname: Shaha
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D002277:Carcinoma; D002291:Carcinoma, Papillary; D015331:Cohort Studies; D003413:Cricoid Cartilage / Q000473:pathology; D005260:Female; D005629:Frozen Sections; D006801:Humans; D007150:Immunohistochemistry; D015994:Incidence; D007430:Intraoperative Care / Q000379:methods; D007830:Larynx / Q000473:pathology; D008197:Lymph Node Excision / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000401:mortality / Q000473:pathology* / Q000556:secondary / Q000601:surgery; D013965:Thyroidectomy / Q000379:methods*; D016896:Treatment Outcome